A Falls Prevention Program on BH Unit, Essay Example

Introduction

Falls are the common reasons of injuries and subsequent deaths in hospital environments. Apart from the fact that nurses are not always able to timely predict and address falls, the lack of comprehensive falls prevention programs contribute in the development of negative organizational, financial, and physiological consequences of patient falls in medical environments. In BH units, the situation may be particularly difficult, given the specificity of BH unit performance, and bearing in mind the growing number of patients admitted to BH units in hospitals. For these reasons, it is not only critical to discuss what falls are and what role they may play in BH unit performance, but to define the basic principles of a good falls prevention program a BH unit can use to reduce the scope of negative fall outcomes.

Falls remain the most serious and the most frequent reason of nonfatal injuries and morbidity in hospitals. All types of healthcare institutions do experience problems with prevention of falls in patients, but nowhere else are falls as relevant as in BH units. It appears that in patients 65 years of age and older, the immediate consequences of a fall, including traumatic brain injury and femur fractions can readily become the causes of premature death (NCPS), and given that of the 44,000 patients in hospital units, almost 20,000 are expected to fall (NCPS), it is more than important for BH units to develop extensive falls prevention programs as a matter of reducing the scope of negative consequences and improving the conditions of hospital care in different population groups.

Throughout my practical experience, I have come to realize the importance of preventing falls in hospital units. Statistically, the cost of falls annually exceeds $20.2 billion, and by 2020 this number will grow to achieve $32.4 billion (NCPS), which means that the problem of falls in different hospital units is more than serious. Unfortunately, not all nurses are able to evaluate the direct factors of falling in patients admitted to BH units, and my practical experience shows this knowledge and understanding being the direct prerequisites of any successful falls prevention program. The combination of factors responsible for falls in patients includes misbalanced medical equipment and medical causes including hypotension, bad eyesight, and cognitive problems (U.S. Department of Veterans Affairs). The absence of movement alarms and too high beds can also be responsible for increased falls and morbidity in patients on BH unit (Anonymous 2). For these reasons, an extensive falls prevention program will include assessment of falls risks and hazards, as well as the means of preventing and reducing these risks on a BH Unit.

A good falls prevention program for BH Unit will begin with the definition of fall. Given that the Joint Commission requires that each unit and hospital develops its own definition of fall (The Joint Commission), the fall for a BH Unit will be defined as “a sudden, uncontrolled, unintentional, downward displacement of the body to the ground or other object, excluding falls resulting from violent blows or other purposeful actions” (NCPS). Based on this definition, BH Unit professionals will have to be particularly attentive to the falls they did not witness, but the consequences of which they are bound to address. In medical practice, un-witnessed falls frequently turn into court cases, which emphasize medical responsibility for preventing falls in medical environments. For example, a patient placed in a waist restraint can readily remove it under the influence of various factors, and without understanding the meaning of his (her) actions (Anonymous 2). The results of such fall, including hip fracture, may result in the subsequent death of the patient as well as significant financial liabilities, which the deceased patient’s relatives may impose on the hospital and the BH unit nurses. For these reasons, un-witnessed falls should be distinguished from the falls, which nurses witness and address immediately.

The next step in developing a good falls prevention program for a BH unit is in the need for creating a highly-qualified and effective team of nurses. That a qualified falls team will reduce the number and scope of negative health consequences of falls is clear. For these purposes, the falls team at a BH unit will include clinical and non-clinical staff (NCPS). Falls clinical nurse specialists, nurse managers, nursing assistants, and physician/ nurse practitioners will become the members of clinical staff, while non-clinical staff will be represented by patient and facility safety managers, transportation managers, and supply procurement managers (NCPS). The main tasks and responsibilities of the falls team will include:

1. developing and implementing effective falls prevention measures;
2. distributing responsibility roles among falls team members;
3. enforcing interdisciplinary approaches to falls prevention;
4. collecting data for aggregate NCPS reviews (NCPS);
5. identifying and monitoring high fall-risk patients in the unit;
6. identifying the impact of falls prevention interventions;
7. providing effective patient transportation as a part of the major falls prevention programs.

The falls team will regularly review falls prevention protocols, investigate and reduce the major causes of falls on the BH Unit, to review falls on daily basis and to act as the source of falls information interdisciplinary teams may need (NCPS).

Risk assessment will become the major and the most important aspect of the newly developed falls prevention program. That means that when admitted, each patient should be assessed on the subject of falls risks and previous history of falls (if available). A well-developed system of assessment will include patient assessment upon admission, assigning the patient with a bed that reduces the risks of fall to minimum, assessing patient balance and coordination during the hospital stay, administering patients with bladder programs to reduce incontinence, and using treaded socks (if possible) (U.S. Department of Veterans Affairs). The major guidelines for risk assessment also require that “older people in the care of healthcare professionals should be asked routinely whether they have fallen in the last year and asked about the frequency, context, and characteristics of the fall” (NCPS). Assessment of falls history should combine with the assessment of osteoporosis risks, older people’s risks of falling, visual and cognitive impairment assessments (NCPS).

Initial assessment of falls risks in patients for a BH unit should be followed by regular and timely assessment of inpatients. That means that a falls team will perform repeated falls analysis of patients in case these are transferred to any other unit, change their status, suffer the consequences of a fall, or without any specific reason on regular basis (NCPS). A combination of Morse and Hendrich assessment forms can be used in order to identify the most problematic risk areas and to identify interventions needed to address each specific level of fall risks (NCPS).

Initial and regular risk assessment should be well balanced with environmental considerations and care. That means that on a BH unit, initial risk assessment and interventions will hardly produce anticipated outcomes, if poorly combined with the specific criteria for environmental safety. Physically safe environments imply that a BH unit eliminates “spills, clutter, electrical cords, and unnecessary equipment” (U.S. Department of Veterans Affairs). Adequate lighting should be provided. Good environmental care also implies that nurses do lock the doors after unlocking them (if not used or unattended) and that patient rooms on a BH unit are located in a way that minimizes the risks of falling (NCPS). All these measures will become the critical elements of environmental falls prevention policy on a BH unit in the hospital.

A good falls prevention policy would be incomplete without a well-developed system of post-assessment in case the patient suffers a fall. Investigating and addressing the causes and consequences of each fall will become an essential element of reducing falls on a BH unit. For these reasons, and following these requirements, the falls team will have to (1) provide immediate post-assessment of the falling case on the unit and (2) provide a follow-up of the case which leads to the elimination of factors responsible for the fall and for the risks of falls in other patients. Such follow-up will also imply the need for developing effective falls treatments and informing all shifts about the fact of falling and the basic interventions developed to address the case (NCPS).

Policy evaluation will become the last component of such program. Obviously, a good program is impossible without a good system of evaluating its effects on patients, the rates of falls and the rates of morbidity following such falls. Regular evaluation will imply that the falls team will, on the one hand, monitor possible changes in the rates and number of falls, and falling trends that emerge in different groups of patients and on the other hand, such evaluation will also require tracing possible changes in standards and policy criteria for falls prevention in hospitals. A BH unit will be responsible for modifying the current falls prevention program to fit policy requirements developed by the Joint Commission or related administrative organs. Finally, the team will be responsible for evaluating the effects (or their absence) of the current program on health risk prevention and its outcomes.

Conclusion

A good falls prevention program for a BH unit will include the need for creating an effective multidisciplinary falls team, developing a reliable system of initial assessment, the standards of regular inpatient assessment and follow up, as well as regular policy evaluation. To reduce the risk of falls will mean to evaluate the risks of falls in patients and to create an environment safe enough for different groups of patients, including those with cognitive and visual impairments. These elements will help the staff reduce the scope and negative consequences of falls on a BH unit.

Works Cited

Anonymous. “Restraint was removed, hospital found liable.” Legal Eagle Eye Newsletter, vol. 17, no. 5 (2009), p. 2.

The Joint Commission. Falls reduction program. 2008. The Joint Commission. 25 September 2009. http://www.jointcommission.org/AccreditationPrograms/LongTermCare/Standards/09_FAQs/NPSG/Patient_falls/NPSG.09.02.01/Fall+reduction+program.htm

NCPS. VHA NCPS Toolkit. 2004. U.S. Department of Veterans Affairs. 25 September 2009. http://www.va.gov/ncps/safetytopics/fallstoolkit/index.html

U.S. Department of Veterans Affairs. VHA NCPS Fall prevention and management. 2004. U.S. Department of Veterans Affairs. 25 September 2009. http://www.va.gov/NCPS/CogAids/FallPrevention/index.html